Study Links Migraine to Emotional Abuse in Childhood

Prolonged stress may alter brain function and structure

VANCOUVER -- Emotional abuse in childhood was associated with increased risk of migraine in adults, particularly in men, results from a preliminary study showed.

While childhood abuse of any kind (sexual, physical, or emotional) increased the chances of a diagnosis of migraine in adulthood by 55% (OR 1.55; 95% CI 1.35-1.77), emotional abuse alone increased the risk of migraine later in life by 52% (OR 1.52; 95% CI 1.34-1.74), according to Gretchen Tietjen, MD, of the University of Toledo, Ohio, and colleagues. "The interplay of depression and migraine on the relationship between childhood abuse and migraine needs to be investigated further," they said in their report, released yesterday and scheduled to be presented in April in Vancouver, Canada, at the American Academy of Neurology's 68th Annual Meeting.

Childhood emotional abuse is common, and commonly associated with migraine in adults, particularly in men, Tietjen said in an interview. In addition, a history of additional types of abuse, such as physical and sexual abuse, increases the strength of the relationship of emotional abuse with migraine. "The relationship of emotional abuse frequency with migraine is U-shaped, suggesting that a certain amount of abuse may lead to resilience, but at high frequency, development of migraine is more likely," she told MedPage Today. "Childhood abuse can have long-lasting effects on health and well-being."

Stephen Silberstein, MD, of Thomas Jefferson University Hospital in Philadelphia, who was not involved with the study, agreed: "Emotional abuse is common and is more common in those who develop migraine," he told MedPage Today. Increasing evidence points to long-term consequences of abuse, he said. "Physicians need to be aware of emotional health in the family."

Data for the study were obtained from 14,484 adults ages 24-32 enrolled in the National Longitudinal Study of Adolescent Health. Participants were asked via questionnaire to recall instances of emotional, physical, and sexual abuse during childhood, and logistic regression was used to model the effect of childhood abuse on migraine, controlling for socio-demographics such as age, income, race, and sex, as well as a history of anxiety and depression.

Physical abuse was defined as being hit with a fist, kicked, or thrown to the floor, into a wall, or down stairs. Sexual abuse included forced sexual touching or sexual relations. About 47% of the participants said they remembered being emotionally abused, while 18% said they had been physically abused and 5% recalled instances of sexual abuse.

A total of 14.2% of the entire cohort reported a diagnosis of migraine. Of this group, 60.5% recalled childhood abuse. Of the group that did not report a history of migraine, 49% recalled abuse in childhood.

When controlled for depression and anxiety, the effect of childhood abuse on migraine remained significant (OR 1.32; 95% CI 1.15-1.51), as did the specific impact of emotional abuse in childhood.

"In contrast to physical and sexual abuse, emotional abuse may be more insidious," Tietjen said. "Emotional abuse, ingrained in the fabric of the family dynamic, may occur over years without recognition or intervention."

As emotional abuse continues, "cumulative stress may lead to dysregulation of the HPA [hypothalamic-pituitary-adrenal] axis and immune, autonomic, and metabolic systems, and alter both brain structure and function," suggested Tietjen. "The question is, can a therapeutic intervention in adulthood alter this trajectory and improve long-term health outcomes?"

Agents that reverse stress-induced epigenetic changes might be particularly useful in the subset of migraineurs who have been abused, and could be examined in clinical trials, she added.

For now, animal studies are underway to better understand the mechanisms behind the migraine-abuse relationship, looking at early life stress and the effect on pain sensitivity, cortical spreading depression, and behaviors associated with anxiety and depression. The investigators are also comparing the regulation of genes associated with stress and inflammation in stressed versus nonstressed animals.

This study was supported by the University of Toledo and the Clair Martig Endowment and will be presented at the 68th annual meeting of the American Academy of Neurology in Vancouver, Canada, Apr. 15-21, 2016. At press time, the paper had not yet been accepted for publication.

More in Meeting Coverage

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.